Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex with Men — King
County, Washington, 1997-1999
Increases in bacterial STDs among gay men points to the need for increased vigilance.

This article documents increases in syphilis, gonorrhea and chlamydia among men who have sex
with men (MSM) in King County, WA, which includes Seattle. By 1996, infectious syphilis had
been eliminated from King County. However, a resurgence of syphilis occurred over the last 2
years, especially among MSM. Reported cases increased from zero in 1996 to 19 in 1997, 42 in
1998, and 46 in the first half of 1999. MSM accounted for 75 (85% of cases) in 1998 and 1999.
Similar increases were reported in gonorrhea and chlamydia rates among MSM attending public
clinics. From 1997 to June 1999, 75% of MSM with syphilis and 18% of those with gonorrhea and
chlamydial infections were infected with HIV highlighting the close link between STDs and the
sexual transmission of HIV.

Inadvertent Use of Bicillin C-R for Treatment of Syphilis — Maryland, 1998The medication used for the treatment of syphilis is easily confused with other penicillin
products.

Three benzathine penicillin G-containing products are currently available in the United
States: Bicillin™ L-A, Bicillin™ C-R and Bicillin™ C-R 900/300. Only Bicillin L-A is
indicated for the treatment of syphilis. Due to the similarities in proprietary name,
packaging, and labeling, Bicillin C-R and Bicillin L-A may easily be confused. A public clinic
in Maryland inadvertently used Bicillin C-R for the treatment of patients with syphilis in the
first 9 months in 1998. As many as 63 clients might have received Bicillin C-R, including 5
pregnant women. Although no definite treatment failures nor cases of congenital syphilis were
identified, re-treatment of patients disrupted routine public health functions and incurred
unnecessary discomfort of patients. A survey of the managers of 55 state and city-level
sexually transmitted diseases (STD) program areas revealed that similar mix-ups occurred in at
least five other program areas during 1993-99.